Yesterday I wrote about MedPAC’s rate recommendations for SNFs for FY 2025. Recall, MedPAC makes these recommendations annually, assuming the full commission votes (in January 2024) for the recommendations as released by draft. The final recommendations go to Congress. Yesterday’s post was the “draft” position for SNFs. Today, I’m including summaries for Home Health, Hospice, and Inpatient Rehab Facilities plus, the meeting (December 7-8) transcript, available here: December-2023-meeting-transcript
Home Health HHA-Dec-2023-SEC
- Cut home health reimbursement (Medicare) by 7%.
- All payer margin = 7.9%.
- 2022 fee-for-service (traditional Medicare) margin = 23%.
- In 2020, Home Health passed SNF as the most popular hospital discharge, post-acute provider.
- By 2021 and 2022, SNF share of discharge market increased while home health decreased. This largely due to staffing challenges.
- Total number of agencies has declined slightly since 2013. This is primarily due to merger and acquisitions in the sector.
- With the implementation of PDGM (no longer thera$33,494 (per patient or times the number of patients).
- Median length of stay = 18 days, average = 95 days. This illustrative of still, a large number of stays being quite short.
- Average visits per week = 3.9.
- Number of agencies grew by 10% in 2022 – all for profit..
- Medicare marginal margin in 2021 was 17%
- Medicare total margin = 13.3% with for profit margins at 19.2% and non-profit at 8.2% (free standing).
Hospice Hospice-Dec-2023-SEC
- No change in rates for FY 2025 – up or down.
- Routine home care represents 98% of days – $218 per day for days 1-60, and $172 per day for days 61 and beyond (FY 2024).
- Aggregate cap = $33,494 x total number of patients.
- 3.9 visits per week on average. Average length of stay = 95 days. Median length of stay = 18 days (reflective of stays being primarily short).
- Number of providers increased by 10% in 2022, all for-profit.
- Medicare marginal margin = 17%.
- Medicare total margin = 13.3%. Freestanding margin = 15.5%. For-profit margin = 19.2%. Non-profit, freestanding margin = 8.5%. Hospital-based margin = -15.6%.
Inpatient Rehabilitation Facilities (IRFs) IRF-Dec-2023-SEC
- Payment reduction of 5%.
- 71% of providers are hospital based.
- Fee for service Medicare = 51% of all discharges.
- Number of facilities remained the same in 2022 but bed counts increased by 2%.
- Aggregate occupancy rate = 68% (no changes year-over-year).
- Medicare marginal profit for hospital-based facilities = 18%; freestanding marginal profit = 39%.
- All payer margin for hospital-based facilities = 2.7%; freestanding all payer margin = 9%.
- Aggregate Medicare margin (2022) = 13.7%. Freestanding = 23%, Hospital-based = 1%.
- 45% (almost) of all freestanding IRFs owned by one company. In 2022, this company opened 9 free standing facilities and added 87 beds to existing IRFs (Encompass formerly known as HealthSouth).